A hydrocoele (US spelling hydrocele) is an accumulation of clear fluid around the testicle. A hydrocoele causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis, a membrane which surrounds the testicle and usually has a thin film of fluid within.
A hydrocoele feels like a small fluid filled balloon inside the scrotum. It is smooth and can vary greatly in size. Hydrocoeles are normally painless and harmless. Large hydrocoeles cause discomfort because of their size. As the fluid of a hydrocoele is transparent, light shone through a hydrocoele may be visible from the other side. Confirmation of the diagnosis is with ultrasound examination of the scrotum.
Hydrocoeles are benign and not dangerous. Usually they are surgically removed if they are causing discomfort due to their size.
Usually the fluid just re-accumulates and there is a risk of introducing infection. For this reason we do not recommend drainage (aspiration).
The main risks of surgery are infection and/or accumulation of blood in the scrotum at the site of the hydrocoele. Both of these occur in about 1 in 20 men (5%). Other rarer risks include shrinkage (atrophy) of the testis, a reduction in fertility and recurrence.
Surgery is usually performed as a day case (home the same day). It performed under general anaesthetic. An incision is made in the scrotum and depending on the size of the hydrocoele the fluid filled sac is opened, drained and repaired to prevent recurrence.
Epididymal Cysts and Spermatocoeles
Epididymal cysts and spermatocoeles are the most common cause of a swelling in the scrotum, and can vary in size from a few millimeters to several centimetres. They are generally not painful. However, some men may experience discomfort.
They can be discovered as incidental scrotal masses found on examination of the testicles. They may also be discovered by self-inspection by the patient. Some patients describe that on examination they have found a third testicle.
Finding a painless, cystic mass above the testicle will usually indicate that an epididymal cyst is the cause of the swelling, but confirmation with an ultrasound is recommended to confirm the diagnosis.
Only large or symptomatic cysts require any treatment, and the recommended treatment is excision of the cyst. Smaller cysts, or those which do not cause symptoms, are best left alone.